Provider Demographics
NPI:1548618408
Name:RELIANCE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:RELIANCE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUDOUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-441-0958
Mailing Address - Street 1:353 US 46
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2415
Mailing Address - Country:US
Mailing Address - Phone:973-276-3213
Mailing Address - Fax:
Practice Address - Street 1:353 US 46
Practice Address - Street 2:SUITE 215
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2415
Practice Address - Country:US
Practice Address - Phone:973-276-3213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory